Demographic and Clinical Characteristics
The study included 34 pediatric patients with a median age of 10 years (range, 3-17 years), and a female to male ratio of 1:1. The demographic and clinical characteristics of the study cohort are shown inTable 1. ALL and AML accounted for the majority of all underlying diseases (56% and 24%, respectively). Twenty-two patients (65%) met high-risk criteria for fungal infection and were given prophylactic itraconazole or fluconazole prior to the diagnosis of AIFR.
Most of the patients developed AIFR during disease remission (23 patients, 68%). In patients post-BMT AIFR was first diagnosed within a median of 112 days post transplantation (range, 6-1203 days). Ten patients (29%) developed AIFR within 6 months of BMT. Thirty-one patients (91%) were severely neutropenic (absolute neutrophil count <500/mm3) at the time of diagnosis of acute infection; the mean duration of neutropenia was 17 ± 14 days (median, 13 days; range, 1-68 days). Fever was the most common presenting symptom of AIFR, in 29 children (85%), followed by facial swelling in eleven (32%). Orbital complications included proptosis (n=4, 12%), periorbital edema (n=3, 9%) and oculomotor nerve palsy (n=3, 9%).